I am confused about the placebo and nocebo effect. Often it is “a fake force”. For example when you try to treat a depressed population, you are picking people at their worst often and there will be regression to the mean. The prototypical story from Wikipedia seems weird:
The mechanism for how placebos could have effects is uncertain. From a sociocognitive perspective, intentional placebo response is attributed to the “ritual effect” that induces anticipation for transition to a better state.[67] A placebo presented as a stimulant may trigger an effect on heart rhythm and blood pressure, but when administered as a depressant, the opposite effect.
I can see how the Placebo effect might be a combination of a whole host of different things where people are just bad at causal attribution. Or a feedback loop gets broken where part of the feedback loop was your own nervous system and cognition. Examples: Chronic pain, RSI, panic attacks (if you believe that your heart exploding in your chest is a sign of something really bad rather than just a panic attack you panic more). This post about the vicious cycle of pain is a good example and has reports of people getting healed from understanding what is going on in the comments. Your pain gets healed by just reading a blogpost on the internet!
Fake treatments can help in such cases if they break that feedback loop. For example by lying to children like in the Mindfield episode: “The power of suggestion”. I am quite confused why it would work this effectively though. We have 3 children. One boy has strong migraines every day for months. One girl keeps picking their arms. One boy is hyperactive/has ADHD (he is 7 or at least very young). They go into a sham MRI machine. They get a watch reminding them that their body can heal them. After that the boy is free of migraines every day or some days weak migraines. The girl stopped picking their arms. The evidence from the ADHD child is absolute weaksauce, because how the fuck do you show that in a video about a 7 year old? What was the team thinking before doing the experiment?
Did Mindfield just get lucky+regression to the mean (seems unlinkely in the migraine case) or does someone here have investigated this further and some people are just really good at this suggestion business and we just need to teach them how to stop lying and how to scale their work in order to heal chronic pain at scale? To be clear I am putting a lot of faith in Mindfield here, though that suggestion generally is a skill that can be improved at seems quite obvious. I have also lots of people reporting in person that other sham treatments are fixing them. For example one teenager reporting the pain in their neck goes away after acupuncture for 4-8 weeks (though usually it only fixes it for a finite amount of time!). I have some trust in Mindfield, where their sample sizes are low, but they actually show you stuff with cameras, which gives you a lot of qualitative information you otherwise don’t get from reading a paper and they don’t shy away from results that go against their narrative. Or is the process just inherently time-intensive? Also has someone ever tried to actually exhaustively fix chronic pain in say 100 cases to classify all the different factors establishing the equilibrium and the kicks that got them out of the attractor. Seems like an obvious thing to try. Also obviously this is the type of thing where you want long-term followup.
(Edit: I got a bit distracted by the immediate application. I think understanding better what is going on in a lot of concrete cases in the first place is quite valuable.)
Read jimmy’s sequence. Stopping pain is something that the brain can easily do. It’s just not something the brain usually does because pain is a valuable signal.
If you take RSI, it’s common that people who suffer from it have tight fascia around their nerves that prevent the nerves from moving in their nerve sheets unimpeded. Doing nerve sliding exercises helps address that problem, I wouldn’t go for convincing the brain to just ignore the signal as the first order of business.
some people are just really good at this suggestion business and we just need to teach them how to stop lying and how to scale their work in order to heal chronic pain at scale
There are plenty of hypnotists who are good at what they do and while some hypnotists do lie, there are many that don’t. There are a lot of institutional reasons why hypnosis doesn’t scale in the current system for pain expect for dentists who offer it as an additional services for pain free dentistry instead of pain killers.
Yeah I didn’t want to imply all chronic pain is not serving a purpose. I meant we should figure out good base rates what the underlying issues are by fixing a bunch of cases exhaustively.
I’m not exactly sure I know what you mean with “fixing a bunch of cases exhaustively” in the current state of medicine. It sounds similar to me like “cure a bunch of cancers exhausively”. It seems quite far outside of what mainstream medicine is equipped to do.
Yeah I didn’t want to imply all chronic pain is psychosomatic
I don’t think that’s a useful way to look at it. Pain arises as a complex interaction between the body and the mind. The pain that patients have at the dentist certainly isn’t psychosomatic, that doesn’t mean that you can shut it off psychologically if you want to do that. It’s just pain.
On the other side, you do need a sense of safety to get acetylcholine release in fascia. Without that you won’t get certain bodily tension released.
If someone has sensor motor amnesia downstream from suppressing an emotion like anger, just shutting of the pain might not solve the psychosomatic issue at it’s base level.
Often it is “a fake force”. For example when you try to treat a depressed population, you are picking people at their worst often and there will be regression to the mean.
This seems plausible for some placebo effects but not nocebo? Also ethical issues aside, isn’t it theoretically really easy to account for regression to the mean with an extra no treatment control group?
Yeah nocebo is more about suggestibility or wrong causal attribution. (Edit: Feedback loops involving your cognition apply in this case as well as for placebo).
I am confused about the placebo and nocebo effect. Often it is “a fake force”. For example when you try to treat a depressed population, you are picking people at their worst often and there will be regression to the mean. The prototypical story from Wikipedia seems weird:
I can see how the Placebo effect might be a combination of a whole host of different things where people are just bad at causal attribution. Or a feedback loop gets broken where part of the feedback loop was your own nervous system and cognition. Examples: Chronic pain, RSI, panic attacks (if you believe that your heart exploding in your chest is a sign of something really bad rather than just a panic attack you panic more). This post about the vicious cycle of pain is a good example and has reports of people getting healed from understanding what is going on in the comments. Your pain gets healed by just reading a blogpost on the internet!
Fake treatments can help in such cases if they break that feedback loop. For example by lying to children like in the Mindfield episode: “The power of suggestion”. I am quite confused why it would work this effectively though. We have 3 children. One boy has strong migraines every day for months. One girl keeps picking their arms. One boy is hyperactive/has ADHD (he is 7 or at least very young). They go into a sham MRI machine. They get a watch reminding them that their body can heal them. After that the boy is free of migraines every day or some days weak migraines. The girl stopped picking their arms. The evidence from the ADHD child is absolute weaksauce, because how the fuck do you show that in a video about a 7 year old? What was the team thinking before doing the experiment?
Did Mindfield just get lucky+regression to the mean (seems unlinkely in the migraine case) or does someone here have investigated this further and some people are just really good at this suggestion business and we just need to teach them how to stop lying and how to scale their work in order to heal chronic pain at scale? To be clear I am putting a lot of faith in Mindfield here, though that suggestion generally is a skill that can be improved at seems quite obvious. I have also lots of people reporting in person that other sham treatments are fixing them. For example one teenager reporting the pain in their neck goes away after acupuncture for 4-8 weeks (though usually it only fixes it for a finite amount of time!). I have some trust in Mindfield, where their sample sizes are low, but they actually show you stuff with cameras, which gives you a lot of qualitative information you otherwise don’t get from reading a paper and they don’t shy away from results that go against their narrative. Or is the process just inherently time-intensive? Also has someone ever tried to actually exhaustively fix chronic pain in say 100 cases to classify all the different factors establishing the equilibrium and the kicks that got them out of the attractor. Seems like an obvious thing to try. Also obviously this is the type of thing where you want long-term followup.
(Edit: I got a bit distracted by the immediate application. I think understanding better what is going on in a lot of concrete cases in the first place is quite valuable.)
Read jimmy’s sequence. Stopping pain is something that the brain can easily do. It’s just not something the brain usually does because pain is a valuable signal.
If you take RSI, it’s common that people who suffer from it have tight fascia around their nerves that prevent the nerves from moving in their nerve sheets unimpeded. Doing nerve sliding exercises helps address that problem, I wouldn’t go for convincing the brain to just ignore the signal as the first order of business.
There are plenty of hypnotists who are good at what they do and while some hypnotists do lie, there are many that don’t. There are a lot of institutional reasons why hypnosis doesn’t scale in the current system for pain expect for dentists who offer it as an additional services for pain free dentistry instead of pain killers.
Implementing prediction-based medicine would be helpful to get this to scale.
Yeah I didn’t want to imply all chronic pain is not serving a purpose. I meant we should figure out good base rates what the underlying issues are by fixing a bunch of cases exhaustively.
I’m not exactly sure I know what you mean with “fixing a bunch of cases exhaustively” in the current state of medicine. It sounds similar to me like “cure a bunch of cancers exhausively”. It seems quite far outside of what mainstream medicine is equipped to do.
I don’t think that’s a useful way to look at it. Pain arises as a complex interaction between the body and the mind. The pain that patients have at the dentist certainly isn’t psychosomatic, that doesn’t mean that you can shut it off psychologically if you want to do that. It’s just pain.
On the other side, you do need a sense of safety to get acetylcholine release in fascia. Without that you won’t get certain bodily tension released.
If someone has sensor motor amnesia downstream from suppressing an emotion like anger, just shutting of the pain might not solve the psychosomatic issue at it’s base level.
This seems plausible for some placebo effects but not nocebo? Also ethical issues aside, isn’t it theoretically really easy to account for regression to the mean with an extra no treatment control group?
Yeah nocebo is more about suggestibility or wrong causal attribution. (Edit: Feedback loops involving your cognition apply in this case as well as for placebo).